Lazy is totally unacceptable... at work anyway.  It's another Sunday and yesterday was housekeeping day.   I found my Solo 401K paperwork sitting on my desk under the mountain of paperwork.  Don't let this be you.  

1.  Grab your EIN (employer Identification number).  This is what you, your accountant or whomever filed your incorporation documents sent on-line to the IRS which makes your company a living number.  For a sep or solo 401k... you need this

2. Your business name as it is in the incorporation documents complete with punctuation  

3.  Print the documents and decide how much you are going to put aside.  

4. Do it and actually send them in.  Your account and tax saving definitely won't start with out this!!

Yesterday, I was catching up on thank you's.  So, I have to vent a little.  Francisco has been a little self-oriented lately and I'm not sure if I have just overly appeased or somehow in thinking of the other... I over did it but I've had to tell him it's not just about him and I need some time for doing... everything.  He cooks and cleans amongst the everyday dog and Elizabeth duty but when I get home it seems that all shifts to me as well... so now I'm having to tell him I have to work on the business, the desk, the rental homes, the bills for the house, accountant, & lawyer.  He's like soooo you going to go to the gym in 30 minutes?  Short of having him do ... because it won't get done... how do I get him to notice all of this because he thinks it's 10 minutes worth of work?? 

I hired help but she has been on vacation and dealing with big family things for weeks.  I missed my oil change yesterday which was severely frustrating.  Francisco says what's the big deal?  Oil is on its last 10% life and I work 5 10's followed by 24 hour call. I'm not sure (when we have 1 car) here just what he thinks I can do and with what time?  

I'm reading reading reading on my gastric sleeve, talking to patients from the surgery, and reviewing everything.  I grow more convinced that I found the correct surgeon.  I think I have the normal pre-surgery jitters and it's months away.  I can't wait to fit into clothes it's been years since I saw.... granted they are mostly in Kansas so I'll be looking like baggy clothes guy for a while as I'm cheap,  in some respects!   

Work,  I was leaving Friday and found security slapped a sticker on my jeep window for move-it or be towed.  I couldn't believe it and I was fuming.  They told me to park in the garage and I did.  They failed to say or show any designated place in the garage.  So I got off early to find said sticker and called them to remove it.  They refused.  I tried to peel it and that was wrong.  I stopped at AutoZone for a razor thingy to get the sticker off... remarkably easier than I thought.   I then apologized to the security people explaining I had never dealt with a sticker and though it would be much worse to remove.  

After the sticker situation I was stuck in a GPS nightmare!  The main road was closed getting home.... construction!!! Seriously the road was fine!!! Drivers on the road they need to fire!  Seriously, they need 1000 cops pulling over these crazy drivers every time they use their car as a battering ram!  I saw an Uber driver with a dash cam... best thing ever!   

Ok, I've vented enough...back to your regularly scheduled life! 

Fun plan

Today I was at a third hospital and people say things like I can't believe you remember from place to place what you need to do.  The good news is anesthesia is anesthesia.  Knowing where everything is even at a place you've worked for a year has a bit of a relativity factor.  Meaning you get used to a place fairly quickly and if you get a halfway decent OR crew, anesthesia tech and are surrounded by decent people... it's probably going to be ok.  

Now, Fun.  Seriously, you have to go to work having fun!  Plan each day to be exciting and happy.  If you drag people down everyday and you are around people stressed and unhappy. Where will your job satisfaction be?   

You have to have fun on the weekends, after work, and plan vacay!!! Life isn't just work.  What you do outside of work leads to your whole self health.  When I get off work I'm going to.... 

If your friend said when I get off work I'm going to take my daughter out for a walk along the river, see the urban culture of a melting pot of people at a skatepark to skulling for their college crew teams, then shower and have a relaxing corona by the pool.  Would you think they were negative about the city or bored?  If you are on an assignment you have to be the person that makes your afterwork and weekend plans.  You have to be the friend that says hey let's go to Atlantic City.    

Every place is what you make of it and it's important to keep yourself and others excited about what you do.  That first plan was my night tonight.  It cost 2$ for the beer and otherwise it was a free nights entertainment.  Your colleagues, nurses, techs don't need to know when you spend $1000 on a trip but they should hear how excited you are about what's happening in their backyard.  It also leads to your overall satisfaction by not becoming TV bound or complacent.  

Best of luck and add some fun to your plan!   


Time is Good

Sometimes locums can be scary but it can also end up a blessing.  We are in between contracts and came for Elizabeth to see the grandparents.   

Today, my dad started to have chest pain and because we have no obligations for a while we are able to help out and make sure all continues to go as smoothly as possible.  

There are definitely plenty of concerns as my Pennsylvania license is now taking longer.  We applied for a temporary now because the state board is now saying they lied about the 6 week processing time and it'll be ten or more weeks.   

We have been hard at work on rentals and preparation for the coming college season.  I have been able to set-up workers and get things going in order to be super set and hopefully not stress things.   

Sooo, here we sit making sure things are ok and we are holding for now.   

My last day!

Another day in the life of a locum CRNA.  You get kind of used to last days.  It's been over a year at this facility and these people are like family.  I truly have been blessed to have known them and worked with them.  Many things happened in my life with these CRNAs and MDAs.  I lost my Grandfather after a long life.  We suffered a miscarriage at 5 months pregnancy and we had our biggest blessing of Elizabeth coming 6 weeks early and my getting stuck in Mexico for nearly 2 months because of law changes and inability to get a birth certificate.  These guys stuck by Francisco and I and poured out support for us.  Tomorrow, is a business day.  It's the day where I say the contract had an end and for reasons of business, I'll be moving on.  I have grown as a CRNA as I do in every environment.  I hopefully have also broadened their expectation and anticipation for Locums in the future.  

Tomorrow, will be another fun day.  I love fun days.  I get to see everyone, smile and give them a happy good morning / afternoon / or evening.  I thank them for the opportunity and say that they never know, our paths could cross in the future.  I try to leave them with a great lasting impression of not only me but all locums so they know we are here when they are in need.  

Today, I called to verify the UHaul.  I verified our stops along the way to Kansas in order to take those things we over-packed and maybe purchased or replaced in the past year.  Hotels were booked.  The truck had it's maintenance.  I verified the bank accounts and deposits for the Massachusetts apartment we will be leaving, the amount for the Philadelphia apartment we will be going to, and then the incidentals we will come into as we go across the US.  

Tomorrow, I will also ensure to take out a minimal sum in cash just in case anything crazy happened and the credit cards caused a problem or there was any number of oh crud moments.  We will return our modem for the internet.  Don't worry ... almost everything works on these smart phones... albeit a tad more challenging.  

Finally, Saturday will come and I will get the UHaul, the movers will show up to help for 2 hours in packing our trailer, and finally we will set out for Buffalo.  

We have a pretty tight schedule to adhere to but one of these days we really want to enjoy some of our extra time off.  :)  

As the plaque on the wall says... Life is in the journey

Getting ready for my new assignment

Francisco, Elizabeth, Bentley, Rosie, and I are all getting ready to change places of work.  We are packing up from Massachusetts after being here for about a year and a half.  We will soon be heading to Philadelphia for what looks like another year or so.  We have looked for an apartment and taken on the risks that come with signing for an apartment in the city.  We have looked for the best option for us as we will look for our daughter, and dogs.  We also have to figure out how to be mobile.  We are downsizing to have just one car which will limit Francisco in going out, taking care of all those things that we have to do in a normal week.  But alas our truck is too large for parking garages and the parking place rental is more than 10% of the rent.

            Pre-assignment I generally call the agency or get an agency call that says the contract is finishing in 30 days or I will be ready to go from a place in 30-90 days.  (I try to plan ahead by 90 days to be ready for credentialing, state needs, and to have time for vacation as I try to take them between contracts.)  If I have a vacation planned I ensure it is a non-negotiable in the contract.  So 60 daysout I like to have a plan of where I am going and be well on the way through credentialing and have my signed contract.  I tend to ask a ton of question pre-contract. 

Where is the assignment. 

What part of the city? 

What city and what is nearby? 

Then the more important things like the hours desired and required? 


Is there any of my favorite types of cases? 

Are they going to make me do my least favorite cases? 

What type of practice is this? 

Why are they looking for help?

Then other important questions:

Rate?  What is the hourly rate?

Where are we going to stay?  Is this lodging going to work for our family?  Can they do a lodging allowance? 

Daily stipend for meals or other?

Daily/weekly mileage or car allowance?

How does all of this work out to an hourly based on a 40 hour work week?  Then is subtract out expenses of malpractice, lodging and any incurred expenses that are beyond what is paid by the agency. This might include licensing, AANA dues, PAC payments, and Student Loans.  Then I look to see if that number works for me. 

After all this is worked out.  I sign a contract.

Once a contract is signed.  I’m going to that assignment.  I don’t back out, I don’t change my mind and I don’t shop around.  Keeping my contracts and obligations is one of the things that keeps me solid in the eyes of the agency and the groups I go to.  I have cancelled after 30 to 60 days with discussions with the agency and a plan of who what when and where. 

Inevitably there is some paperwork to be done so I get that and generally complete it over a weekend and mail it back ASAP. 

Then it’s just waiting out the end of the contract and a vacation.  Moving time comes and we pack/unpack over a period of about 4 days with a Uhaul. 

In the new town I will drive to my hospital so I know GPS is correct for getting there and construction doesn’t have me totally messed up.  I scout out what I’ll need such as gyms, groceries, movies, pediatricians, vets and get the lay of the land. 

The morning of the start.  I generally arrive earlier than when paperwork states to arrive.  I do this because if they are short… I’ll be in the OR day 1 hour 1 and I like to have a clue of what I’m doing.  Second… If I’m there with the chief or before… they can’t see me as lazy or showing up late. 

What many people forget is what happens or is fact may not be reality.  Perception is reality until proven otherwise.  Having to prove otherwise means we are starting in the hole.  One of my assignments had multiple locums come and go and one of the last had taken the patient to the PACU turning blue and had not recognized the patient had gone apneic.  (at least that is what I heard from multiple sources)  Either way… when I arrived MDA’s were anti-locum and CRNA’s didn’t trust that I had a clue what anesthesia was.  One of my first cases I went to push my drugs and the MDA began to scream at me that the state law was XYZ and that’s how they practiced here and I could leave if I didn’t like it.  I nearly walked out and left him with the patient.  Weeks turned into months at this facility and the demeanor shifted.  My perception of them shifted some but I expect AMG’s with MDA supervision of CRNAs to act in a certain manner where I expect a CRNA only group to function in certain ways… and no they are not the same expectations.  AMG and MDA supervision… it’s how they operate and I do what I need to in order to keep the patient safe.  Second, the MDA’s name is on the chart. If they are insecure and petulant I show them that I’m not an idiot.  I call them when something occurs so that when out of the room they can handle a post-op cardiac work-up or manage the ICU setting.  They are close to or as liable as we are despite presence not being in the room.  If I question something or if anyone in the room says should I call the doc… I don’t take offense and say “please”.  Even an OR nurse can make life a disaster if you are managing a complication but they feel you should call the MDA.  They will go sing to the congregation whether correct or not. 

Otherwise, I try to maintain a generally happy-go-lucky attitude, smile, and be kind to all.  Sounds crazy but that is probably the number one factor in my staying at facilities longest or returning to facilities time and time again.